None listed
Conditions
Brief summary
We propose to evaluate the usefulness of cough testing for reducing chest infection in patients with stroke. All inpatients referred to stroke services team and referred for swallowing evaluation in a 9 month period will be approached for participation in the study. Those participants who agree to participate will be randomly assigned to either a 1) standard evaluation group or 2) standard evaluation with inclusion of cough testing. For those in the experimental group, citric acid in a mist will be inhaled through a face mask to assess cough response. These results will contribute to usual clinical decision making. Outcomes for both groups will be measured by chest infection rates by 3 months post discharge and other clinical indicators of swallowing impairment. If successful in reducing complications associated with stroke, this test can be easily implemented without significant cost or resources and consequently reduce the impact of stroke on health status and quality of life.
Interventions
For participants in the experimental group, the standard swallowing evaluation will be completed with the inclusion of cough reflex testing. This will occur as a one -off intervention at the time of inital assessment. Initially a placebo (0.9% Sodium choride (NaCl)) dose without citric acid will be presented to coach the participant on task completion.
The PulmoMate Compressor/Nebuliser by deVilbiss (model 4650I) with a predetermined flow output of 8 litres per minute will be turned on for a p
For participants in the experimental group, the standard swallowing evaluation will be completed with the inclusion of cough reflex testing. This will occur as a one -off intervention at the time of inital assessment. Initially a placebo (0.9% Sodium choride (NaCl)) dose without citric acid will be presented to coach the participant on task completion. The PulmoMate Compressor/Nebuliser by deVilbiss (model 4650I) with a predetermined flow output of 8 litres per minute will be turned on for a period of 15 sec. Presence of absence of cough during the period of administration will be documented. This test will be repeated three times with the same concentration at 30 sec intervals, with a 30 second interval between each inhalation to prevent tachyphylaxis. Cough reflex will be identified as present when participants cough on at least two out of the three inhalations. If patients cough readily on all three presentations of the lower concentration, the clinician will ask the patient to try to suppress the cough at this level. Participants will be asked to “try to suppress the cough as much as they can”. The suppressed cough threshold will be reached when participants cough at least two out of three inhalations. For patients assigned to the experimental condition, the cough reflex test will be administered using a face mask method which was recently evaluated to establish normative data in New Zealand (NZ). These data, which have established the citric acid concentrations at which healthy individuals in two age groups (equal gender representation) produce a spontaneous cough and a suppressed cough, will be shortly available: Monroe, M., Huckabee, M.L., Robb, M.P. (in progress). Citric-Acid Inhalation Cough Challenge – Establishing Normative Data. University of Canterbury, Swallowing Rehabilitation Research Laboratory at the Van der Veer Institute.
Sponsors
Centre for Clinical Research and Effective Practice (CCRep)
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All stroke patients referred for clinical or diagnostic swallowing assessment from the two hospital sites will potentially be included in the study.
Exclusion criteria
Patients on mechanical ventilation for respiratory support will be excluded from the study
Outcome results
None listed